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A case report of peripartum cardiomyopathy with a review of literature

Peripartum cardiomyopathy (PPCM) is a severe form of idiopathic dilated cardiomyopathy, which appears either in the last month of pregnancy or during the five months

following delivery. This clinical entity leads to left ventricular dysfunction and eventually cardiac insufficiency. Left ventricle functions recover spontaneously in some

patients with PPCM while left ventricular dysfunction persists to cause an indication for cardiac transplantation in some patients. This case report aims to increase the

awareness of obstetricians about PPCM by describing an affected patient.

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The review of neuroimaging findings of 139 patients with idiopathic intracranial hypertension: A clinical retrospective experience

Aim: Idiopathic intracranial hypertension (IIH), or pseudotumor cerebri is a challenging condition with raised intracranial pressure (ICP) in the absence of identifiable

cause. Typical clinical manifestations can be a headache, tinnitus, papilledema, and decreased vision. The diagnosis is established by the Modified Dandy

Criteria. Several brain Magnetic Resonance Imaging (MRI) findings have been associated with the diagnosis of IIH. The aim of this study is to determine the

characteristics of IIH and establish whether there are characteristic appearances on MRI and MRV that are being routinely overlooked in our clinical practice.

Material and Method: All patients with a diagnosis of IIH between January 2010 and January 2018 at Bakırköy Mental Health Education and Training Hospital

of Neurology, Neurosurgery, and Psychiatry were enrolled. The diagnosis of IIH was established according to the Modified Dandy Criteria (Table 1). Only patients

who had available images of MRV examination and/or MR imaging examination during the period of review were included. Electronic medical records

were reviewed for clinical parameters such as symptom profile, age, gender, opening pressure at lumbar puncture and neuroimaging. Each case was reviewed

independently by a neuroradiologist and a neurologist. Results: One hundred thirty-nine patients were included in the study. The patient group consisted of 114

females and 25 males, ages 17-72 years (38.13 ± 11.51). The most common symptom was a headache, which was noted in 84 %. Papilledema was found in

118 patients (86.33 %). In the neurological examination,7 patients had abducens nerve palsy (Table 2). Opening pressure on lumbar puncture was available in

the hospital chart for 130 of the 139 IIH patients (93.5 %). Opening pressure ranged from 160 to 800 mm H2O (mean: 365 mm H2O; 1 standard deviation=130

mm H2O). One hundred twenty-two of 139 patients had abnormal opening pressure. Eight of the 139 patients hadnormal opening pressure (<250 mm H2O).

The MRI was normal in 66 patients ( 47.5 %). The MRI disclosed flattening of the posterior eyeballs and vertical tortuosity of the orbital optic nerve in 6.5 %,

optic nerve hyperintensity in 2.2 %, empty cella in 24.5 %, Chiari malformation in 4.3 %, and optic nerve hyperintensity together with empty cella in 9.4 % of

patients (Table 3). There was no evidence of sinus thrombosis on the static images of the patients. Unilateral transverse sinus hypoplasia was perceived in

19.4 % of patients. Bilateral TS stenosis was perceived categorically in 20.9 % of patients with IIH. Discussion: The study detects that empty cella, optic nerve

enhancement on MRI and bilateral transverse sinus stenosis on MRV are mostly seen neuroimaging findings in IIH patients. The presence of Chiari Malformation

on MRI is also the supportive clue of IIH in the absence of sinus thrombosis. Conclusion: MRI is an important imaging technic to support the diagnosis of

IIH. With further investigations, MRI can be enough to diagnose the disease in the future and it will also provide cost- effectiveness.

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Antibiotic resistance profiles of endotracheal aspirates in intensive care unit patients

Aim: In the patients hospitalized in intensive care units (ICU) infectious agents of the lower respiratory tract are nosocomial pathogens that causes severe

morbidity and mortality. The aim of our study is to determine the bacterial growth and antibiotic resistance profiles of bacterias isolated from endotracheal aspirate

cultures (ETA) obtained from ICU’s of our hospital for the last one year. Material and Method: Between October 2017 and September 2018, ETA samples

from adult intensive care units were examined retrospectively. In addition to conventional methods, identification and antibiotic susceptibilities were studied

in accordance with the recommendations of the European Committee on Antimicrobial Susceptibility Testing (EUCAST) using fully automated VITEC (Biomerieux,

France). Results: Of the 205 ETA specimens from adult ICU’s, 113 growths were detected in 103 patients. In ETA, 37 (32,7%) Acinetobacter baumannii,

29 (25,6%) Pseudomonas aeruginosa, 13 (11.5%) Staphylococcus aureus, 12 (%10,6) Klebsiella pneumoniae, 6 (5,3%) Escherichia coli, 4 (3,5%) Enterobacter

cloacae and 2 (1,7%) Stenotrophomonas malthophiliae was isolated. Meropenem and imipenem resistance of A. baumannii was 89.1% for both, whereas it

was 48,2% and 51,7% for P. auroginosa, respectively. Colistin and tigesiklin resistance was not detected for all isolates. Oxacillin resistant S.aureus strains

were determined as 46.1% (6/13), while linezolid, teicoplanin, and vancomycin resistance were not detected. Discussion: Increased carbapenem resistance

observed in antimicrobial susceptibility tests, for the most frequently bacterias isolated from ETA samples in ICU of our hospital, has shown the importance

of the antimicrobial susceptibility testing.

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